Over-the-scope clip to close bleeding pancreaticoduodenal fistula Chaitanya Allamneni, MD  VideoGIE  Volume 3, Issue 6, Pages 183-184 (June 2018) DOI: 10.1016/j.vgie.2018.04.003 Copyright © 2018 Terms and Conditions

Figure 1 A, CT of the abdomen/pelvis with severe acute pancreatitis, with several peripancreatic gas-containing fluid collections, and periduodenal fluid collections with air within the collection, suggesting fistula. Decreased pancreatic parenchymal enhancement suggesting pancreatic necrosis; also seen are multiple calcifications within the pancreatic head consistent with chronic pancreatitis. B, C, Initial EGD with no bleeding source identified in the esophagus, stomach, or duodenum. B, Normal second part of the duodenum on EGD, with Dobhoff tube visualized. C, Colonoscopic view was also unremarkable, with only small internal hemorrhoids visualized. D, E, Repeated EGD after hematochezia revealed a blood clot (D), thought to be overlying the minor papilla, at the duodenal sweep. E, Placement of 2 endoclips proximal to the bleeding lesion for further endoscopic versus interventional radiology access. F, EUS view showing no evidence of pancreatic divisum with an anatomically normal pancreatic duct. G, Major and minor papilla visualized on repeated endoscopy. The blood clot thought to be overlying the minor papilla was in fact visualized at a separate location. H, Deployment of over-the-scope “bear claw” clip to close bleeding fistula. VideoGIE 2018 3, 183-184DOI: (10.1016/j.vgie.2018.04.003) Copyright © 2018 Terms and Conditions